Doctor Name: | MRS. MISTY FAULK WILLIS |
NPI Number: | 1053645697 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NURSE PRACTITIONER |
License Number: | RN177038 |
Business Practice Address: | 312 Westside Drive Douglas, GA - 31533 |
Business Phone Number: | 9123842200 |
Business Fax Number: | 9123837992 |
Mailing Address: | 312 Westside Drive, DOUGLAS |
State: | GA |
Postal Code: | 31533 |
Phone Number: | 9123842200 |
Fax Number: | 9123837992 |
NPI Enumeration Date: | 09/30/2009 |
NPI Last Update Date: | 09/30/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN177038 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |